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Traumatic chylothorax: A case report and review.

Sendama W, Shipley M - Respir Med Case Rep (2015)

Bottom Line: An 84-year-old lady presented to the emergency department after being found collapsed at home.Chylous drainage of 1l/24hr was observed.Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, South Tyneside District Hospital, Harton Lane, South Shields NE34 0PL, United Kingdom.

ABSTRACT
Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container. Pleural fluid examination revealed a lymphocyte-rich transudate with high levels of cholesterol and triglycerides. CT imaging of the chest, abdomen and pelvis revealed an acute left sided pulmonary embolus, and a multisegment burst fracture of the L1 vertebra. The patient was anticoagulated for the pulmonary embolus. Conservative fracture management was advised. Chylous drainage of 1l/24hr was observed. Due to ongoing chylous leak the patient was commenced on a medium-chain fatty acid diet and octreotide. Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury. Spinal trauma can rarely cause disruption of the thoracic duct and chylothorax. Diagnosis of chylothorax hinges on the typically high triglyceride content of chylous fluid and the detection of chylomicrons where the triglyceride concentration is equivocal. Management options for persistently draining chylothorax are varied and range from non-invasive medical measures to radiological and surgical interventions (although the patient in the case we present was an unsuitable candidate for surgery). We discuss pertinent diagnostic testing and put forward possible medical management strategies for chylothorax.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray demonstrating progression of effusion.
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fig1: Chest X-ray demonstrating progression of effusion.

Mentions: On day 4 of admission, the patient experienced increasing breathlessness with reduced breath sounds noted in the right lung field on auscultation. A repeat chest X-ray showed a progression of the right-sided effusion with an unchanged small left-sided effusion [Fig. 1].


Traumatic chylothorax: A case report and review.

Sendama W, Shipley M - Respir Med Case Rep (2015)

Chest X-ray demonstrating progression of effusion.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356050&req=5

fig1: Chest X-ray demonstrating progression of effusion.
Mentions: On day 4 of admission, the patient experienced increasing breathlessness with reduced breath sounds noted in the right lung field on auscultation. A repeat chest X-ray showed a progression of the right-sided effusion with an unchanged small left-sided effusion [Fig. 1].

Bottom Line: An 84-year-old lady presented to the emergency department after being found collapsed at home.Chylous drainage of 1l/24hr was observed.Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, South Tyneside District Hospital, Harton Lane, South Shields NE34 0PL, United Kingdom.

ABSTRACT
Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container. Pleural fluid examination revealed a lymphocyte-rich transudate with high levels of cholesterol and triglycerides. CT imaging of the chest, abdomen and pelvis revealed an acute left sided pulmonary embolus, and a multisegment burst fracture of the L1 vertebra. The patient was anticoagulated for the pulmonary embolus. Conservative fracture management was advised. Chylous drainage of 1l/24hr was observed. Due to ongoing chylous leak the patient was commenced on a medium-chain fatty acid diet and octreotide. Whilst chylous drainage ceased the patient died from infected pressure sores, malnutrition and acute kidney injury. Spinal trauma can rarely cause disruption of the thoracic duct and chylothorax. Diagnosis of chylothorax hinges on the typically high triglyceride content of chylous fluid and the detection of chylomicrons where the triglyceride concentration is equivocal. Management options for persistently draining chylothorax are varied and range from non-invasive medical measures to radiological and surgical interventions (although the patient in the case we present was an unsuitable candidate for surgery). We discuss pertinent diagnostic testing and put forward possible medical management strategies for chylothorax.

No MeSH data available.


Related in: MedlinePlus